The value of identifying self-harm patients who repeat with rising suicidal intent is discussed. A study is described measuring changes in intent with repetition by means of an intent scale. Patients repeating once in 5 years scored significantly higher in intent for their second episodes, while multiple repeaters tended to score lower for second episodes. Patients under the age of 35 were most at risk for repetition with increasing intent within 2 years. No correlation emerged between the rise in intent and the time interval between episodes over a 7-year period. The 5-year suicide rate was higher among rising intent repeaters than other cases. These findings are discussed.

Twenty patients who had taken long-term benzodiazepines were submitted to brain CT scan examinations. Some scans appeared abnormal. The mean ventricular/brain area measured by planimetry was increased over mean values in an age- and sex-matched group of control subjects but was less than that in a group of alcoholics. There was no significant relationship between CT scan appearances and the duration of benzodiazepine therapy. The clinical significance of the findings is unclear.

The covariation over time of depressive symptoms was studied by repeated ratings of the symptoms of individual depressed in-patients. Both within-patient factor analysis of symptom scores and correlation of symptom change scores to total change scores suggested that, while the symptoms of reduced interest and pleasure covaried closely with ratings of observed and reported low mood, the more ‘biological’ symptoms of sleep and appetite disturbance showed little covariation. The implications for the study of depression are discussed.

Data collected from 6043 psychiatric in-patient records were analysed to assess the impact of a strike at a mental hospital on in-patient services in general hospital psychiatric units in St John's, Newfoundland, Canada. As a whole, during the strike general hospital units showed an increase in the number of involuntary admissions, the number of prior mental hospital admissions of patients, and indications of violent or suicidal behaviour; and a decrease in the occupational status of patients admitted and the prescription of minor tranquillizers. There was also evidence of considerable variation between general hospitals in the extent to which their admission pattern changed during the strike and the permanence of some of the strike effects. The data indicate that all patients showing violent or suicidal behaviour who would normally have been admitted to the mental hospital were treated in the general hospital units during the strike. On the other hand, a large number of patients diagnosed with schizophrenia, personality disorder or mental retardation, who normally would have been admitted to the mental hospital, apparently went without hospitalization during the strike. A substantial proportion of this latter group would usually have been admitted involuntarily.

Behaviour disturbance was investigated in mentally handicapped adults who were living in hospital or at home. The first part of the study describes an empirically derived typology of disturbed behaviour patterns and gives the details of a scale by means of which behaviour disturbance can be quantified along six dimensions: aggression, mood disturbance, communicativeness, antisocial conduct, idiosyncratic mannerisms, and self-injury. The second part of the study used the scale in a longitudinal study of behavioural disturbance. Different forms of disturbed behaviour exhibited different kinds of longitudinal stability, and the long-term changes in one aspect of disturbance depended on subjects' other disturbance scores.

Platelet aggregatory responses to adenosine diphosphate (ADP) and arachidonic acid were examined in 6 drug-free schizophrenics, 5 other drug-free psychotics, 8 ‘acute-on-chronic’ schizophrenics (on long-term neuroleptic therapy) and 38 healthy controls. Platelet aggregation and disaggregation following ADP was significantly lower in ‘acute-on-chronic’ schizophrenics (on drugs) compared with healthy controls, and disaggregation following 1 µM ADP was significantly less in drug-free schizophrenics. The difference between maximum aggregation induced by ADP and that induced by arachidonic acid was significantly greater in schizophrenics (both on drugs and drug-free) than in controls. These findings are related to possible abnormalities of central nervous system function in schizophrenia.

Twenty-two psychiatric patients who committed suicide while receiving hospital treatment or within 3 months of discharge from psychiatric care were studied using general population statistics, a random sample of 100 psychiatric patients and a control group matched individually with the hospital suicides. The rate of suicide among psychiatric in-patients was over 50 times that in the general population. A higher vulnerability to suicide was detected among in-patients (v. other patient groups), men (v. women) and middle-aged patients (v. older and younger patients). Suicides were differentiated from controls in having suffered more losses (P < 0·05), being psychiatrically ill for the first time (P < 0·05), having a past history of deliberate self-harm (P < 0·05), and not receiving a schizophrenic diagnosis (P < 0·02). People with mid-life crises, patients who swing rapidly into depression while receiving treatment, and individuals who are judged to be depressed because of personal problems may carry a particularly high suicide risk during psychiatric treatment.

Two groups of open heart surgery patients, one receiving prostacyclin and one placebo, were assessed one week pre-operatively and 3 months post-operatively, using a battery of clinical tests measuring a variety of cognitive functions. No significant differences between the groups were detected, apart from a visual retention deficit at 3 months in the prostacyclin group. The results cast doubt on previous findings suggesting that prostacyclin reduces cognitive deficits following open heart surgery.

Depression following withdrawal from long- or short-term use of benzodiazepines is not uncommon, yet it is under-reported in the benzodiazepine withdrawal literature. Four cases of depressive illness supervening during benzodiazepine withdrawal are reported. Depression may, it is suggested, be an integral part of the benzodiazepine withdrawal syndrome.

A 7% one-year prevalence rate of conspicuous psychiatric morbidity was found in patients attending a single general practice. The nature of the morbidity was examined by a detailed assessment of mental state and personality, using interview schedules administered by a psychiatrist. Depressive disorders were presented by nearly half of the patients. The overall sex incidence of the disorders was equal, but alcohol abuse was more common in males. A personality disorder was present in 33·9% of all patients seen, although it was rarely diagnosed as the primary problem and was linked to the diagnosis of anxiety states, rather than depressive neurosis. These findings are discussed in relation to other epidemiological studies in primary care.

Three hundred and eighty former concentration camp inmates were identified and interviewed in the course of a community health survey in Jerusalem. A set of 8 questions derived from the Cornell Medical Index was used as an index of emotional distress. The concentration camp survivors had a higher prevalence of emotional distress and more symptoms of this type than other European-born members of the community, controlling for age and education. The findings suggested that 16·0% of the emotional distress observed in male camp survivors and 22·9% of that among female camp survivors could be attributed to the camp experience almost three decades after the Holocaust. In this survey, data were elicited in a context unrelated to benefit-seeking such as clinic or compensation claims.

In a randomized, controlled trial neurotic patients (mainly phobics and obsessive-compulsives) in primary care were assigned to behavioural psychotherapy from a nurse therapist or to routine care from their general practitioner. At the end of one year clinical outcome was significantly better in patients cared for by the nurse therapist. Economic outcome to one year, compared with the year before entering the trial, showed a slight decrease in the use of resources by the nurse therapist group (N = 22), and an increase in resource usage in the GP-treated group (N = 28), mainly due to the letter's increased absence from work and more hospital treatment and drugs. On the reasonable assumptions that nurse therapists treat 46 patients a year and that such patients treated behaviourally maintain their gains for 2 years, the economic benefits to society from nurse therapists treating such patients may outweigh the costs. This excludes any monetary value on the substantial clinical gains such as reduction in fear and anxiety. However, the numbers are small, few economic differences were significant, and many patients either did not complete the trial or waiting-list periods or they failed to return economic data. Conclusions must thus be tempered with caution, even though pre-treatment demographic and clinical data of non-returners were comparable with those of returners, and though the few drop-outs who could be rated at one year had not improved. The findings cannot be extrapolated to other types of clinical problem and treatment.

This paper compares the coverage of potential life events by the inventory developed by Tennant & Andrews (1976) and the post hoc designation originated by Brown (1974). It was found that the rubric of the inventory failed to describe 5% of ‘marked’ events and 21% of ‘moderate’ events. The relative risk of minor psychiatric disorder in response to events was 3·1 for those defined by the Brown technique and 1·4 for those using the inventory. The results suggests that the post hoc designation is superior. This superiority must be weighed against its undoubted costliness.

Trends in the incidence and causes of sudden deaths in a hospital group for the mentally handicapped were identified during a 50-year period, and the two halves of the period were compared. There were significantly more deaths in the second 25-year period than in the first. Longevity was greater during the second period, and a decrease in deaths due to status epilepticus was outweighed by an increase in deaths from arterial degenerative disease in the larger number of older patients. In the second period there was also a significant rise in sudden deaths due to asphyxia, probably attributable to modern medication with side-effects giving rise to feeding difficulties.